Combined phacoemulsification and trabeculectomy with mitomycin-C

BACKGROUND AND OBJECTIVE: To evaluate the effectiveness of combined phacoemulsification and trabeculectomy with mitomycin-C with respect to visual rehabilitation and control of intraocular pressure in patients with coexisting cataract and glaucoma. PATIENTS AND METHODS: The authors retrospectively studied 20 consecutive cases of phacoemulsification with posterior chamber intraocular lens implantation combined with trabeculectomy using mitomycin-C. They included in their study 20 eyes of 19 patients with primary open-angle glaucoma, pseudoexfoliation glaucoma, inflammatory glaucoma, chronic angle-closure glaucoma, and normal tension glaucoma. RESULTS: After a mean postoperative follow-up time of 14.4 ± 3.1 months, intraocular pressure was reduced from a preoperative mean of 19.2 ± 6.1 mm Hg to a postoperative mean of 13.4 ± 3.9 mm Hg (P = .0004). The number of required intraocular pressure-lowering medications dropped from a pre- operative mean of 2.3 ± 0.7 medications to 0.2 ± 0.4 medications postoperatively (P < .0001), with only 4 eyes requiring the restarting of a single medication each. Mean tog₁₀ (minimum angle of resolution) visual acuity improved from a preoperative 0.66 ± 0.53 (Shelien 20/91) to a postoperative 0.30 ± 0.40 (Shelien 20/40) (P < .0005). The most frequent complication was a bleb leak (8 of 20 eyes [40%]), usually occurring early and responding to conservative management. One eye with later-onset bleb leak incurred endophthalmitis. In another eye, hypotony with maculopathy developed. CONCLUSIONS: Phacoemulsification combined with trabeculectomy using mitomycin-C appears to be an effective approach to the management of cataract in patients with glaucoma. It offers potential for good improvement in visual acuity as well as long-term control of intraocular pressure with reduced or no dependence on medications. Potential vision-threatening complications of this procedure, specifically hypotony maculopathy and later- onset bleb leaks, should be considered in the decision to use mitomycin-C.